NURS 3356 Notes 1 - Antepartum -Community Care and Culture
Review math!
Learning Objectives for
Antepartum Chapter 1 – Issues and
Trends *
Identify, define and apply the concepts of the following terms
• Healthy People 2020
o Provides science-based national objectives and goals across all life stages, esp. reducing rate of fetal
& infant deaths, rate of maternal mortality, reducing preterm births, reducing C-section births
among low-risk women.
o To have healthy moms & babies the mom needs to maintain a healthy lifestyle and needs to
have access to medical care. RN responsibility is to both mom and fetus – 2 pts
o EMTLA – emergency medical treatment & labor act – ensures that anyone coming to the
hospital (ER) uninsured will be treated
• Problems with the US Healthcare system- define and solutions
o Expensive, inaccessible (lack of money, transportation, childcare, physicians refusing to
take Medicaid)
▪ US has higher cost of healthcare than the next 12 countries on the list. Physician
involvement with nurse practitioners is required in all states except 16 (costly). Most
insurance will not reimburse mid wives or nurse practitioners fully.
o Vulnerable populations: women, pregnant, minorities, incarcerated, homeless, etc.
o Info on the internet helpful for pts to become involved in their own care
o Infant mortality may be affected by financial, educational, sociocultural, and behavioral
factors. Barriers to care must be removed and services modified to meet needs.
• Trends in Fertility and Birth rate
o Low Birth weight & preterm birth – increases risks for morbidity & mortality
o Morbidity and Mortality both maternal and infant – incidence higher in AA babies. Factors: limited
maternal education, young maternal age, unmarried status, poverty, lack of prenatal care,
smoking, poor nutrition, alcohol use, maternal health conditions.
▪ Maternal mortality rate small, but a problem b/c most are preventable (usually
HTN, infection, hemorrhage, CV disease – major cause)
o Obesity – more than 1/3 women in US obese; racial disparity, increases risk from HTN & diabetes;
also decreased fertility, congenital anomalies, miscarriage, fetal death
• Trends in Nursing Practice
o Specialization, advanced degrees, certification programs
o Nurses in advanced practice may provide primary care
• Standards of Practice and Legal Issues
o Legislation enacted for mothers/babies to stay in hospital at least 48 hrs after vag birth & 96
after cesarean if desired
o AWHONN (Association of Women Health Care & Neonatal Nursing) publishes standards of practice
& education for perinatal nurses: “Standards & Guidelines for Professional Nursing Practice in the
Care of Women & Newborns),” including an evidence-based approach to practice
▪ Must document! RN can be sued by pts for up to 18 yrs & 3 mos after delivery
o “Failure to rescue” - a death after a treatable complication. RN failed to recognize or act on
early signs of distress. Must identify complication through careful surveillance and put
1
,NURS 3356 Notes 1 - Antepartum -Community Care and Culture
appropriate measures in place through quick action.
2
,NURS 3356 Notes 1 - Antepartum -Community Care and Culture
o Sentinel event – “unexpected occurrence involving death or serious physical or psychological
injury, or risk thereof. Serious injury specifically includes loss of limb or function.” - any maternal
death related to process of birth, perinatal death unrelated to congenital condition, infant
discharge to wrong family, severe neonatal hyperbilirubinemia, etc.
Chapter 2 – Community Care and Culture
Identify Family
• Primary unit of socialization – whoever the pt considers to be family (nuclear, extended,
multigenerational, no-parent, married-blended, cohabiting parent, single parent, homosexual)
Identify cultural factors and the implications for nursing; define culture
Using childbearing beliefs and practices identify, define, and provide culturally appropriate care
• Definitions
o Subculture – a group within a larger cultural system that retains its own characteristics
o Acculturation – changes that occur w/in a group when mixing or contacting other cultures – often
in times of crisis or change (like childbearing) a woman may rely on old cultural patterns even after
acculturation
o Assimilation – when cultural group loses identity & becomes part of dominant culture
o Ethnocentrism – the view that one’s own culture’s way of doing things is best
o Cultural relativism – the opposite of ethnocentrism
• Culture has a direct effect on health
• Nurse’s role: develop cultural competence and integrate it into the nursing care plan, often
considering health promotion rather than illness care
• Some main differences:
o Childbearing beliefs & practices
o Personal space
o Time orientation
o Family roles
• Important to recognize disparity between nurse’s culture & pt’s culture, educate & promote healthy
behaviors in cultural context that has meaning for pts, apply abstract cultural knowledge in a practical
way, have respect for differences (including nontraditional & alternative), recognize importance of
culturally different communication styles, problem-solving techniques, concepts of space & time, and
desire to be involved with care decisions
• Communication often the most challenging part obstacle for nurses working with people from
other cultures. Use translators/interpreters when necessary
• Review pg. 27 (K)
Identify, define and provide appropriate nursing care to vulnerable Populations
• Vulnerable populations are groups who are at higher risk for development of physical, mental, or social
health problems, with racial and ethnic disparities existing for a number of health conditions and
services
o Women in general
o socioeconomically disadvantaged
o racial & ethnic minorities (poverty, higher rates of chronic disease, preterm labor, LBW)
o adolescent girls (risky behaviors, misinformed)
o older women (chronic illness)
3
, NURS 3356 Notes 1 - Antepartum -Community Care and Culture
o incarcerated women (unstable relationships, no family support, emotional stability, lifestyle choices)
o immigrant, refugee, and migrant women (not US citizens, fear of deportation, poverty)
o homeless women (nutrition, lifestyle, risk for injury & illness, victim of domestic
abuse, transportation)
o rural women (lack of transportation, far from medical care, poverty)
• Treat with dignity, avoid judgment, be professional, exhibit cultural sensitivity, be nonthreatening
Apply to guidelines for nursing practice for home care in the community
• Partnerships among community residents and health workers necessary
• Three levels of preventative care:
o Primary – immunizations, exercise, nutrition
o Secondary – targeting populations at risk for certain diseases – screenings
o Tertiary – rehab
• Variety of health-promoting strategies used; prepared childbirth classes, publications, coalitions, faith-
based organizations helpful
• Home care – extension of in-hospital care
o Pros: bed rest maintained, neonate not exposed to infection, teaching tailored to home
conditions, safety & resources assessed
o Cons: limited availability of nurses, nurse safety, expensive
• Telephonic nursing – internet & Skype, telemedicine; less expensive
o nursing assessments after postpartum home care visit reassess pt’s knowledge
• Perinatal home care incorporates knowledge from community health nursing, acute care nursing,
family therapy, health promotion, and client education
• Referrals – consider health status of both pts, availability of med care in community, family resources,
level of home support & care, availability of third party reimbursement, cost-effectiveness
• Nursing considerations
o Careful history of meds, ensure taking correctly
o Teach how to respond in emergency situation
o If using medical equipment, inspect equipment/environment/electricity
o Give written instructions as well as verbal ; share info on support groups
o Follow protocol & do psychosocial assessment
o Documentation, forms – third party payers base payment on nurse written record
o Communicate with health care provider about any new orders required
Chapter 3 – Nursing and Genomics
Identify and define the various genetic testing in the childbearing family
• Family history important – single most cost-effective piece of information (complete = three generations)
o Preconception ideal time for this
• Most tests now offered are tests for single-gene disorders in pts with clinical symptoms or w/ family Hx
of genetic disease
• Maternal serum screening
• Fetal ultrasound or sonogram
• Invasive procedures (chorionic villus sampling & amniocentesis)
• Noninvasive testing for fetal aneuploidy – abnormal # of chromosomes w/in a cell (now recommended for
all women during prenatal assessment)
4
Review math!
Learning Objectives for
Antepartum Chapter 1 – Issues and
Trends *
Identify, define and apply the concepts of the following terms
• Healthy People 2020
o Provides science-based national objectives and goals across all life stages, esp. reducing rate of fetal
& infant deaths, rate of maternal mortality, reducing preterm births, reducing C-section births
among low-risk women.
o To have healthy moms & babies the mom needs to maintain a healthy lifestyle and needs to
have access to medical care. RN responsibility is to both mom and fetus – 2 pts
o EMTLA – emergency medical treatment & labor act – ensures that anyone coming to the
hospital (ER) uninsured will be treated
• Problems with the US Healthcare system- define and solutions
o Expensive, inaccessible (lack of money, transportation, childcare, physicians refusing to
take Medicaid)
▪ US has higher cost of healthcare than the next 12 countries on the list. Physician
involvement with nurse practitioners is required in all states except 16 (costly). Most
insurance will not reimburse mid wives or nurse practitioners fully.
o Vulnerable populations: women, pregnant, minorities, incarcerated, homeless, etc.
o Info on the internet helpful for pts to become involved in their own care
o Infant mortality may be affected by financial, educational, sociocultural, and behavioral
factors. Barriers to care must be removed and services modified to meet needs.
• Trends in Fertility and Birth rate
o Low Birth weight & preterm birth – increases risks for morbidity & mortality
o Morbidity and Mortality both maternal and infant – incidence higher in AA babies. Factors: limited
maternal education, young maternal age, unmarried status, poverty, lack of prenatal care,
smoking, poor nutrition, alcohol use, maternal health conditions.
▪ Maternal mortality rate small, but a problem b/c most are preventable (usually
HTN, infection, hemorrhage, CV disease – major cause)
o Obesity – more than 1/3 women in US obese; racial disparity, increases risk from HTN & diabetes;
also decreased fertility, congenital anomalies, miscarriage, fetal death
• Trends in Nursing Practice
o Specialization, advanced degrees, certification programs
o Nurses in advanced practice may provide primary care
• Standards of Practice and Legal Issues
o Legislation enacted for mothers/babies to stay in hospital at least 48 hrs after vag birth & 96
after cesarean if desired
o AWHONN (Association of Women Health Care & Neonatal Nursing) publishes standards of practice
& education for perinatal nurses: “Standards & Guidelines for Professional Nursing Practice in the
Care of Women & Newborns),” including an evidence-based approach to practice
▪ Must document! RN can be sued by pts for up to 18 yrs & 3 mos after delivery
o “Failure to rescue” - a death after a treatable complication. RN failed to recognize or act on
early signs of distress. Must identify complication through careful surveillance and put
1
,NURS 3356 Notes 1 - Antepartum -Community Care and Culture
appropriate measures in place through quick action.
2
,NURS 3356 Notes 1 - Antepartum -Community Care and Culture
o Sentinel event – “unexpected occurrence involving death or serious physical or psychological
injury, or risk thereof. Serious injury specifically includes loss of limb or function.” - any maternal
death related to process of birth, perinatal death unrelated to congenital condition, infant
discharge to wrong family, severe neonatal hyperbilirubinemia, etc.
Chapter 2 – Community Care and Culture
Identify Family
• Primary unit of socialization – whoever the pt considers to be family (nuclear, extended,
multigenerational, no-parent, married-blended, cohabiting parent, single parent, homosexual)
Identify cultural factors and the implications for nursing; define culture
Using childbearing beliefs and practices identify, define, and provide culturally appropriate care
• Definitions
o Subculture – a group within a larger cultural system that retains its own characteristics
o Acculturation – changes that occur w/in a group when mixing or contacting other cultures – often
in times of crisis or change (like childbearing) a woman may rely on old cultural patterns even after
acculturation
o Assimilation – when cultural group loses identity & becomes part of dominant culture
o Ethnocentrism – the view that one’s own culture’s way of doing things is best
o Cultural relativism – the opposite of ethnocentrism
• Culture has a direct effect on health
• Nurse’s role: develop cultural competence and integrate it into the nursing care plan, often
considering health promotion rather than illness care
• Some main differences:
o Childbearing beliefs & practices
o Personal space
o Time orientation
o Family roles
• Important to recognize disparity between nurse’s culture & pt’s culture, educate & promote healthy
behaviors in cultural context that has meaning for pts, apply abstract cultural knowledge in a practical
way, have respect for differences (including nontraditional & alternative), recognize importance of
culturally different communication styles, problem-solving techniques, concepts of space & time, and
desire to be involved with care decisions
• Communication often the most challenging part obstacle for nurses working with people from
other cultures. Use translators/interpreters when necessary
• Review pg. 27 (K)
Identify, define and provide appropriate nursing care to vulnerable Populations
• Vulnerable populations are groups who are at higher risk for development of physical, mental, or social
health problems, with racial and ethnic disparities existing for a number of health conditions and
services
o Women in general
o socioeconomically disadvantaged
o racial & ethnic minorities (poverty, higher rates of chronic disease, preterm labor, LBW)
o adolescent girls (risky behaviors, misinformed)
o older women (chronic illness)
3
, NURS 3356 Notes 1 - Antepartum -Community Care and Culture
o incarcerated women (unstable relationships, no family support, emotional stability, lifestyle choices)
o immigrant, refugee, and migrant women (not US citizens, fear of deportation, poverty)
o homeless women (nutrition, lifestyle, risk for injury & illness, victim of domestic
abuse, transportation)
o rural women (lack of transportation, far from medical care, poverty)
• Treat with dignity, avoid judgment, be professional, exhibit cultural sensitivity, be nonthreatening
Apply to guidelines for nursing practice for home care in the community
• Partnerships among community residents and health workers necessary
• Three levels of preventative care:
o Primary – immunizations, exercise, nutrition
o Secondary – targeting populations at risk for certain diseases – screenings
o Tertiary – rehab
• Variety of health-promoting strategies used; prepared childbirth classes, publications, coalitions, faith-
based organizations helpful
• Home care – extension of in-hospital care
o Pros: bed rest maintained, neonate not exposed to infection, teaching tailored to home
conditions, safety & resources assessed
o Cons: limited availability of nurses, nurse safety, expensive
• Telephonic nursing – internet & Skype, telemedicine; less expensive
o nursing assessments after postpartum home care visit reassess pt’s knowledge
• Perinatal home care incorporates knowledge from community health nursing, acute care nursing,
family therapy, health promotion, and client education
• Referrals – consider health status of both pts, availability of med care in community, family resources,
level of home support & care, availability of third party reimbursement, cost-effectiveness
• Nursing considerations
o Careful history of meds, ensure taking correctly
o Teach how to respond in emergency situation
o If using medical equipment, inspect equipment/environment/electricity
o Give written instructions as well as verbal ; share info on support groups
o Follow protocol & do psychosocial assessment
o Documentation, forms – third party payers base payment on nurse written record
o Communicate with health care provider about any new orders required
Chapter 3 – Nursing and Genomics
Identify and define the various genetic testing in the childbearing family
• Family history important – single most cost-effective piece of information (complete = three generations)
o Preconception ideal time for this
• Most tests now offered are tests for single-gene disorders in pts with clinical symptoms or w/ family Hx
of genetic disease
• Maternal serum screening
• Fetal ultrasound or sonogram
• Invasive procedures (chorionic villus sampling & amniocentesis)
• Noninvasive testing for fetal aneuploidy – abnormal # of chromosomes w/in a cell (now recommended for
all women during prenatal assessment)
4
